ISSN 1671-5411 CN 11-5329/R
Volume 20 Issue 4
Apr.  2023
Turn off MathJax
Article Contents
Please cite this article as: ZHANG S, SUN DH, LI S, LI Y. How to effectively manage the refractory coronary thrombus? A systemic mini-review. J Geriatr Cardiol 2023; 20(4): 309−313. DOI: 10.26599/1671-5411.2023.04.003
Citation: Please cite this article as: ZHANG S, SUN DH, LI S, LI Y. How to effectively manage the refractory coronary thrombus? A systemic mini-review. J Geriatr Cardiol 2023; 20(4): 309−313. DOI: 10.26599/1671-5411.2023.04.003

How to effectively manage the refractory coronary thrombus? A systemic mini-review

doi: 10.26599/1671-5411.2023.04.003
More Information
  • Corresponding author:
  • Available Online: 2023-04-18
  • Publish Date: 2023-04-28
  • The main management principle for patients with coronary thrombus should be “more removal and less implantation”. Routine thrombus aspiration (TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus. It is unwise to implant a stent in the vessel with high residual thrombus, which is associated with no-reflow, impaired microvascular perfusion, and consequently worse clinical outcomes. Therefore, increasing the efficiency of TA during percutaneous coronary intervention procedures, especially under some conditions of refractory coronary thrombus, is very important to restore myocardial reperfusion and improve microvascular dysfunction early. In the present work, we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.
  • loading
  • [1]
    Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015; 372: 1389−1398. doi: 10.1056/NEJMoa1415098
    Fröbert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013; 369: 1587−1597. doi: 10.1056/NEJMoa1308789
    Bhindi R, Kajander OA, Jolly SS, et al. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Eur Heart J 2015; 36: 1892−1900. doi: 10.1093/eurheartj/ehv176
    Vlaar PJ, de Smet BJ, van den Heuvel AF, et al. Operator dependence of outcome after primary percutaneous coronary intervention. EuroIntervention 2011; 6: 760−767. doi: 10.4244/EIJV6I6A129
    Higuma T, Soeda T, Yamada M, et al. Does residual thrombus after aspiration thrombectomy affect the outcome of primary PCI in patients with ST-segment elevation myocardial infarction? An optical coherence tomography study. JACC Cardiovasc Interv 2016; 9: 2002−2011. doi: 10.1016/j.jcin.2016.06.050
    Hara H, Nakamura M, Komatsu H, et al. Comparison of the in vitro performance of 6 and 7 French aspiration catheters. EuroIntervention 2007; 2: 487−492.
    Takahashi S, Saito S, Tanaka S, et al. New method to increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv 2004; 63: 452−456. doi: 10.1002/ccd.20223
    Li Y, Xue JY, Sun YM, et al. [Successful coronary intractable thrombus aspiration with sub-5F catheter in three patients]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42: 878−879. [In Chinese]. doi: 10.3760/cma.j.issn.0253–3758.2014.10.017
    Sheng L, Li JQ, Sun DH, et al. Removal of refractory thrombus by 5F child catheter in patients with subacute myocardial infarction. J Geriatr Cardiol 2019; 16: 168−172. doi: 10.11909/j.issn.1671-5411.2019.02.010
    Moretti A, Sanz Sanchez J, Petriello G, et al. Ultra-deep guide catheter intubation for direct thromboaspiration in acute myocardial infarction. Cardiovasc Revasc Med 2019; 20: 49−50. doi: 10.1016/j.carrev.2019.08.011
    Kusumoto H, Hasegawa K, Ishibuchi K, et al. A novel treatment using a guide extension catheter and distal protection device for refractory coronary embolism: case report. Eur Heart J Case Rep 2021; 5: ytaa507. doi: 10.1093/ehjcr/ytaa507
    Jain A, Weerackody R, Kennon S, et al. Prevention of thrombus embolization during primary percutaneous intervention using a novel mesh covered stent. Catheter Cardiovasc Interv 2009; 74: 88−93. doi: 10.1002/ccd.21981
    Uribe CE, Zuñiga M, Madrid C. Mechanical thrombectomy using the Solitaire stent in a left main coronary artery: a novel approach to coronary thrombus retrieval. Catheter Cardiovasc Interv 2017; 89: 71−77. doi: 10.1002/ccd.26545
    Khoo DZL, Lee JH, Watson TJ, et al. The Solitaire device: on the cards for retrieval of recalcitrant thrombus in acute coronary syndrome. EuroIntervention 2019; 14: e1834−e1835. doi: 10.4244/EIJ-D-18-00234
    Scalone G, Brugaletta S, Garcia-Garcia HM, et al. Frequency and predictors of thrombus inside the guiding catheter during interventional procedures: an optical coherence tomography study. Int J Cardiovasc Imaging 2015; 31: 239−246. doi: 10.1007/s10554-014-0544-3
    Collins N, Horlick E, Dzavik V. Triple wire technique for removal of fractured angioplasty guidewire. J Invasive Cardiol 2007; 19: E230−E234.
    Demircan S, Yazici M, Durna K, et al. Intracoronary guidewire emboli: a unique complication and retrieval of the wire. Cardiovasc Revasc Med 2008; 9: 278−280. doi: 10.1016/j.carrev.2007.11.003
    Devidutta S, Lim ST. Twisting wire technique: an effective method to retrieve fractured guide wire fragments from coronary arteries. Cardiovasc Revasc Med 2016; 17: 282−286. doi: 10.1016/j.carrev.2016.01.013
    Zou YL, Li JQ, Gong YT, et al. A novel treatment of refractory coronary embolism: thrombus aspiration catheter-assisted twisting wire technique. J Geriatr Cardiol 2020; 17: 110−115. doi: 10.11909/j.issn.1671-5411.2020.02.005
  • 加载中


    通讯作者: 陈斌,
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索


    Article Metrics

    Article views (105) PDF downloads(19) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint